MEDICARE: CALHOUN COUNTY HEALTH DEPARTMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1770647729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALHOUN COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	117 W ASH ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 W ASH ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2912
Country	:	US
Telephone Number	:	361-552-9721
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BAIN CATE
Credential	:	M.D.
Telephone Number	:	361-552-9721

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/07/2007

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Directions to “CALHOUN COUNTY HEALTH DEPARTMENT ” Practice Location

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